Small Mammal GI Disease

Question 1

What kind of digestive system do small herbivores have?
How does their GI transit time differ to monogastrics?

Answer 1

Hindgut fermentation
Faster GI transit time

Question 2

Can rabbits and rodents vomit?

Answer 2

No

Question 3

What dietary component is essential for small herbivore gut motility?

Answer 3

Fiber

Question 4

How do small herbivores process food “twice”? What benefit does this have?

Answer 4

Cecotrophy - eat droppings to process them again to gain maximal nutritional value

Question 5

What is the PLACE rule? List these medications

Answer 5

Antibiotics that you should never give orally to small herbivores because they come with VERY high risk
- Penicillins
- Lincosamides
- Aminoglycosides
- Cephalosporins
- Erythromycins

Question 6

How can aminoglycosides be used safely in small mammals?

Answer 6

can be used topically (not absorbed that way) - never orally

Question 7

How can you remember which Medications are appropriate to use For Treating Small Mammals?

Answer 7

Medications For Treating Small Mammals?
Metronidazole
Fluoroquinolones
Tetracyclines
Sulphonamides
Macrolides

Question 8

Which macrolide is not appropriate for use in small mammals?

Answer 8

Erythromycin

Question 9

Which group of antibiotics is commonly used in small mammals?

Answer 9

Fluoroquinolones

Question 10

What are the factors which can cause gut stasis in small mammals?

Answer 10

Question 11

What are the factors which can cause diarrhea in small mammals?

Answer 11

Question 12

What is gut stasis in small mammals?

Answer 12

inadequate digestion - not a diagnosis
Usually associated with anorexia
Can have potentially fatal consequences if left untreated

Question 13

What is very important to note on physical exam of a patient experiencing gut stasis?

Answer 13

Mouth/teeth/gums - look for evidence of overgrowth or issues with conformation
Watch animal from a distance and see how they act naturally
Listen to gut sounds

Question 14

List primary vs secondary GI disease signs associated with gut stasis in small mammals?

Answer 14

Primary GI Disease should be strongly suspected if:
- Hx of poor diet/recent dietary change
- An abnormality is palpable in the gut (Ex. foreign body)
- The onset of gut stasis preceded any development of signs of
malaise (depression and/or anorexia)
Secondary GI Disease may be suspected if:
- History of stress
- Obvious source of pain (Ex. dental disease)

Question 15

Why might an animal in severe pain look bright and alert in the clinic?

Answer 15

Prey animals - need to look ok in order to survive

Question 16

What are the steps of stabilizing an animal with gut stasis?

Answer 16

1. Oxygen
2. Warmth
3. Fluids
4. Nutrition
5. Analgesia
   +/- Prokinetics? (Stimulate gut to move more)
   - If first 5 steps are done properly, not necessary to give prokinetics!

Question 17

What is the normal temperature range for a rabbit?

Answer 17

38-39.5C

Question 18

Do rabbits have a lower or higher BMR compared to dogs and cats? How should you adjust the fluid rate to compensate for this?

Answer 18

Higher MBR in rabbits
Need to double fluid rate

Question 19

What is the typical maintenance fluid rate for rabbits with gut stasis? What kind of fluids should you give (plus what additive and why)?

Answer 19

100 ml/kg/day
Warm SQ fluids + hyaluronidase 1500IU/L
Hyaluronidase aids distribution/absorption of fluids throughout the body

Question 20

Why is nutrition so important for rabbits with gut stasis? How much should you feed a patient if completely anorexic? What should the entire team know how to do in terms of feeding the patient?

Answer 20

Important because the patient needs to be getting nutrition and encouraging gut motility
Feed patient 50 ml/kg/day split between 3-5 feeds
- NG tube placement occasionally necessary
Important that whole team is aware of how to feed the patient properly

Question 21

What are the pharmacological options for analgesia in small mammals with GI disease?

Answer 21

NSAIDs - Meloxicam
Opioids - Buprenorphine
Metoclopramide
Ranitidine
Cisapride

Question 22

What kind of medication is Meloxicam?
What is the dosing? What other medication should you consider giving in conjunction?

Answer 22

NSAIDs - Meloxicam
- < 0.6mg/kg q12hrs, Ensure well-hydrated
- Consider gastroprotectant

Question 23

What kind of medication is Buprenorphine?
What is the dosing?
What does this medication do to gut motility and why is it still ok to give in these patients?

Answer 23

Opioids - Buprenorphine
- < 0.05 mg/kg q6-8hrs
- Normally slows down guts, but if animal is in pain it treats the pain
rather than only slowing down guts
- Important to use for pain reduction (fewer side effects when
medication is actually doing its job)

Question 24

What kind of medication is Metoclopramide?
Where does it work?
What effect does this medication have on gut motility?

Answer 24

• Anti-emetic
• Prokinetic + effects on Ach release, dopamine/serotonin receptors
• Works on esophagus, stomach and small intestine
• Little or no effect on colonic motility

Question 25

What kind of medication is Ranitidine? What is it used to treat? Which receptors does it work on? Where does it work and what effect does it have on colonic motility?

Answer 25

- Used for treatment of GI ulcers - Works on histamine H2 receptors but also prokinetic due to effects on acetylcholinesterase inhibition - Works on proximal GI tract but may stimulate colonic motility

Question 26

What kind of medication is cisapride? Where does this medication work? Is this medication more or less potent than metoclopramide?

Answer 26

- Prokinetic agent - Works on serotonin receptors to indirectly stimulate Ach release - Works on esophagus, stomach and small intestine - More potent than metoclopramide

Question 27

When is surgery required for gut stasis patients?

Answer 27

When obstruction is present

Question 28

What are the indications that an obstruction is present?

Answer 28

- Visualization of foreign body - Gastric dilation - Gas shadows in the SI cranial to an obstruction - Serial radiographs to check if gas is moving through to hindgut

Question 29

Are blood tests indicated in gut stasis patients?

Answer 29

May be indicated if systemic disease suspected (renal, hepatic, lead/zinc levels) Elevated glucose levels can indicate severity of condition

Question 30

Can you define the lesion in every case of gut stasis? How do most cases resolve?

Answer 30

No - Most cases resolve with symptomatic treatment

Question 31

When should GA be considered?

Answer 31

Consider GA for full oral exam and further imaging

Question 32

How do you approach diarrhea in small mammals?

Answer 32

Same as in cats and dogs

Question 33

What is important to distinguish from diarrhea in rabbits? How do you do this?

Answer 33

Cecotrophs - get a really good history, do a really good oral exam (teeth may be overgrown and rabbit might not be able to pick up cecotrophs to eat them)

Question 34

How do you stabilize a rabbit with diarrhea?

Answer 34

Oxygen Warmth Fluids Nutrition Analgesia

Question 35

How do you treat coccidia in rabbits?

Answer 35

Trimethoprim-sulphonamide Toltrazuril

Question 36

What is cholestyramine and how is it used for diarrhea?

Answer 36

binds enterotoxins

Question 37

Are antibiotics indicated? Probiotics?

Answer 37

Abx only indicated for bacterial enteritis (metronidazole) Probiotics do no harm